Information Collection Request

[NCCDPHP] Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Reporting System

ICR 202502-0920-014 · OMB 0920-0612 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-0621 WISEWOMAN-MDE_Manual_23.1 Form and Instruction Modified Available
Form 0920-0612 WISEWOMAN Program MDE Manual Edition 18.3R Form and Instruction Modified Available
Form 0920-0612 WISEWOMAN Program Minimum Data Elements (MDE) Form and Instruction Modified Repair queued
Form 0920-0621 WISEWOMAN-MDE_Annual Progress Report Form and Instruction Modified Available
WISEWOMAN Annual Progress Report Form and Instruction Modified Available
Annual Progress Report Form and Instruction Modified Repair queued
Attachment 9 Summary Exhibits_Minor Changes_04082025.pdf Supplementary Document Uploaded 2025-04-08 Repair queued
Attachment 9 Summary Exhibits_Minor Changes_04082025.pdf Supplementary Document Uploaded 2025-04-08 Repair queued
WISEWOMAN 0920-0612 SSB F_Updated_04072025.docx Supporting Statement B Uploaded 2025-04-08 Repair queued
WISEWOMAN 0920-0612 SSB F_Updated_04072025.docx Supporting Statement B Uploaded 2025-04-08 Repair queued
WISEWOMAN 0920-0612 SSA F_Updated_04072025.docx Supporting Statement A Uploaded 2025-04-08 Repair queued
WISEWOMAN 0920-0612 SSA F_Updated_04072025.docx Supporting Statement A Uploaded 2025-04-08 Repair queued
WISEWOMAN SPD-15 Justification.docx Supplementary Document Uploaded 2025-03-12 Repair queued
WISEWOMAN SPD-15 Justification.docx Supplementary Document Uploaded 2025-03-12 Repair queued
Attachment 1b WISEWOMAN Program Managers Directors and Data Managers.pdf Supplementary Document Uploaded 2025-03-12 Repair queued
Attachment 1b WISEWOMAN Program Managers Directors and Data Managers.pdf Supplementary Document Uploaded 2025-03-12 Repair queued
Attachment 5b Web Portal Upload Screen Shot.pdf Supplementary Document Uploaded 2025-03-12 Repair queued
Attachment 5b Web Portal Upload Screen Shot.pdf Supplementary Document Uploaded 2025-03-12 Repair queued
Attachment 5a Web Portal Login Screen.pdf Supplementary Document Uploaded 2025-03-12 Repair queued
Attachment 5a Web Portal Login Screen.pdf Supplementary Document Uploaded 2025-03-12 Repair queued
Attachment 7c Summary of Public Comments.pdf Public Comments Uploaded 2025-03-12 Repair queued
Attachment 7c Summary of Public Comments.pdf Public Comments Uploaded 2025-03-12 Repair queued
Attachment 7c Summary of Public Comments.pdf Public Comments Uploaded 2025-03-12 Repair queued
Attachment 7b_WISEWOMANFederalRegisterNotice2024.pdf Supplementary Document Uploaded 2025-03-12 Repair queued
Attachment 7b_WISEWOMANFederalRegisterNotice2024.pdf Supplementary Document Uploaded 2025-03-12 Repair queued
Attachment 1a Map of WISEWOMAN Awardees.pdf Supplementary Document Uploaded 2025-03-12 Repair queued
Attachment 1a Map of WISEWOMAN Awardees.pdf Supplementary Document Uploaded 2025-03-12 Repair queued
OMB Change Request_08182023.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-08-22 Repair queued
OMB Change Request_08182023.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-08-22 Repair queued
OMB Change Request_04182023.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-04-18 Repair queued
OMB Change Request_04182023.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-04-18 Missing upstream
Att 7 Consent Guidance.pdf Supplementary Document Uploaded 2022-08-11 Repair queued
Att 7 Consent Guidance.pdf Supplementary Document Uploaded 2022-08-11 Missing upstream
60-day FRN_06022022.pdf Supplementary Document Uploaded 2022-08-11 Repair queued
60-day FRN_06022022.pdf Supplementary Document Uploaded 2022-08-11 Missing upstream
Att 2b WISEWOMAN Prg Mgrs Dirs Data Mgrs.pdf Supplementary Document Uploaded 2022-08-11 Repair queued
Att 2b WISEWOMAN Prg Mgrs Dirs Data Mgrs.pdf Supplementary Document Uploaded 2022-08-11 Repair queued
Att 2a WISEWOMAN Awardees Map.png Supplementary Document Uploaded 2022-08-11 Repair queued
Att 2a WISEWOMAN Awardees Map.png Supplementary Document Uploaded 2022-08-11 Repair queued
Att 1b Sec 301 PHSA.pdf Supplementary Document Uploaded 2022-08-11 Repair queued
Att 1b Sec 301 PHSA.pdf Supplementary Document Uploaded 2022-08-11 Missing upstream
Att 1a NBCCEDP Law Statute.pdf Supplementary Document Uploaded 2022-08-11 Repair queued
Att 1a NBCCEDP Law Statute.pdf Supplementary Document Uploaded 2022-08-11 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
37802 WISEWOMAN Program Minimum Data Elements (MDE) Form and Instruction ModifiedWISEWOMAN-MDE_Manual_23.1
37802 WISEWOMAN Program Minimum Data Elements (MDE) Form and Instruction ModifiedWISEWOMAN Program MDE Manual Edition 18.3R
37802 WISEWOMAN Program Minimum Data Elements (MDE) Form and Instruction Modified
37802 WISEWOMAN Program Minimum Data Elements (MDE) Instruction Modified
191867 Annual Progress Report Form and Instruction ModifiedWISEWOMAN-MDE_Annual Progress Report
191867 Annual Progress Report Form and Instruction ModifiedWISEWOMAN Annual Progress Report
191867 Annual Progress Report Form and Instruction Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
08/31/2028 36 Months From Approved
120 0 0
2,640 0 0
0 0 0





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Annual Progress Report 0920-0621, None ,  
WISEWOMAN Program Minimum Data Elements (MDE) 0920-0621, 0920-0612 ,  

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 120 0 0 0 0 120
Annual Time Burden (Hours) 2,640 0 0 0 0 2,640
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No